The challenge TPAs face today
Third-party administrators must stand up and maintain a wide range of client-specific benefit designs, each with its own eligibility rules, cost-sharing structures, accumulators, prior authorization requirements, provider networks, and funding models. Traditional plan-build processes often rely on one-off spreadsheets, custom code, and tribal knowledge. The result is slow onboarding, inconsistent quality, and operational risk every time a new client arrives or an existing one changes benefits mid-year.
What “modular workflows” mean in practice
A modular approach breaks a plan into reusable building blocks, benefit components, rules, and templates, that can be assembled into client-specific configurations without writing new code. Instead of recreating the wheel for every employer or payer partner, you select and combine pre-vetted modules (e.g., deductible options, tiered copay schedules, network rules, specialty carve-outs), then apply client-specific parameters.
With AxisCore, HealthAxis provides rules-driven workflows that make this modular approach practical for busy operations teams:
- Rules-driven configuration. Plan logic is captured as human-readable rules that determine eligibility, cost-share, and adjudication behaviors.
- Templates and libraries. Common plan patterns become templates that can be cloned and parameterized across contracts.
- Non-technical usability. Operations and product staff can configure and update plans through guided workflows with no heavy development cycles.
- Change control. Versioning and approvals enforce governance, so every change is tracked and auditable.
This approach aligns technical rigor with operational speed, so your business can say “yes” to more nuanced client needs without adding complexity.
How it comes together
- Multi-state employer with varied cost-sharing. A TPA needs to launch a PPO with HSA-compatible options in some states and standard PPO cost-sharing elsewhere. Using AxisCore, the team selects an HSA-compliant deductible/coinsurance module for applicable states, applies a copay module for others, and assigns the appropriate network rules, all from established templates. Mid-year adjustments become parameter changes, not custom projects.
- Specialty carve-out for high-cost therapies. An employer introduces a specialty drug program with distinct prior authorization logic. The team adds a specialty pharmacy module with pre-defined authorization rules and ties it to the relevant formulary and network settings. The change is governed through approvals, and the updated configuration can be reused when another client requests a similar carve-out.
- Union group with unique eligibility windows. A fund requires alternating eligibility periods based on hours worked. The eligibility module is applied with parameters reflecting the client’s hour thresholds and look-back rules, again, without introducing bespoke code.
These are common TPA patterns that benefit from modular, rules-based assembly and controlled reuse.
What are the benefits of using a modular approach
1) Faster commercialization without tech debt
Say “yes” to differentiated RFP requirements by assembling from a trusted catalog rather than coding from scratch. This compresses onboarding timelines and reduces reliance on scarce engineering cycles.
2) Governance and risk control
Standardized components reduce variance in plan builds. Approvals and versioning ensure changes are intentional, reviewable, and reversible.
3) Operational scalability
When client growth outpaces engineering headcount, modularity lets operations scale plan setup and maintenance predictably. New hires ramp up faster because they work with guided workflows and repeatable templates.
4) Lower cost to serve
Reusable modules cut the hidden costs of one-off builds, requirements gathering, development, QA, and convert them into parameter changes handled by the business.
The bottom line
AxisCore simplifies the setup of diverse client-specific plans using rules-driven workflows that minimize technical effort. By making plan logic modular, reusable, and governed, TPAs can support dozens of clients with unique plan needs, without heavy dev work or platform complexity.
Let’s talk
If you’re ready to reduce onboarding times, expand your catalog of differentiated benefit designs, and scale without expanding technical headcount, HealthAxis can help.
Contact us to see AxisCore’s modular plan setup in action and explore how a rules-driven approach can accelerate your growth while strengthening control.
